Individual
MS. JESSICA ELAINE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, LD
Contact information
Practice address
3910 CAUGHEY RD STE 200, ERIE, PA 16506-4098
(814) 580-8808
Mailing address
3910 CAUGHEY RD STE 200, ERIE, PA 16506-4098
(814) 580-8808
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN007374
PA
133V00000X
Registered Dietitian
LD.09340
OH
Other
Enumeration date
01/13/2021
Last updated
09/25/2024
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